Prognostic Significance of Endothelial Dysfunction in Hypertensive Patients

• DOI: 10.1161/01.cir.104.2.191
• Publication Date: 2012-06-12T00:09:32Z
• Authors: Francesco Perticone; Roberto Ceravolo; Arturo Pujia; Giorgio Ventura; Saverio Iacopino; Angela Scozzafava; Alessandro Ferraro; Massimo Chello; Pasquale Mastroro...; Paolo Verdecchia; Giuseppe Schillaci
• Keywords: Endothelial Dysfunction; Sodium nitroprusside; Stroke; Basal (medicine)

Background — Forearm endothelial dysfunction, characterized by an impaired vasodilating response to acetylcholine (ACh), may be associated with several cardiovascular risk factors, including essential hypertension. Although the prognostic value of coronary dysfunction has been demonstrated, that forearm is still unknown. Methods and Results Endothelium-dependent -independent vasodilation was investigated in 225 never-treated hypertensive patients (age, 35 54 years) intra-arterial infusion increasing doses ACh sodium nitroprusside. Patients were divided into tertiles on basis their increase ACh-stimulated blood flow (FBF) from basal: group 1, 30% 184%; 2, 185% 333%; 3, 339% 760% basal. During a mean follow-up 31.5 months (range, 4 84 months), there 29 major adverse events at cardiac (n=19), cerebrovascular (n=9), or peripheral vascular (n=1) level. Events included myocardial infarction, angina, revascularization procedures, stroke, transient cerebral ischemic attack, aortoiliac occlusive disease. Event rate per 100 patient-years 8.17, 4.34, 2.02 first, second, third peak percent FBF during infusion. The excess first tertile significant (relative risk, 2.084; 95% CI, 1.25 3.48; P =0.0049) after controlling for individual markers, 24-hour ambulatory pressure. Conclusions Our data suggest marker future